Core lecture series in MSK Radiology

Transcription

1 Curriculum in Musculskeletal Imaging (rev 01/6/11) Faculty pint persn: Margaret A. Stull, MD Diagnstic Radilgy Residency: Brke Army Medical Center Other teaching faculty in MSK Radilgy: 1. Je Witham, MD (SLH) 2. Jessica Martinez (SLH) 3. Larry Ricci, MD (SLH) 4. Amit Verma (KCVA) 5. Radhika Gupta (KCVA) adult MRI 6. Jim Brwn, MD (CMH) plain radigraphs 7. Jshua Knwltn, MD (CMH) sprts injury 8. Brentn Reading, MD (CMH) sprts injury Cre lecture series in MSK Radilgy Cre lectures - Biweekly year rund 7:30pm at SLH 1. Traumatlgy: Osseus and Sft tissue Basic imaging techniques 2. Traumatlgy: Osseus and Sft tissue Advanced imaging techniques 3. Orthpedic Hardware and Cmplicatins 4. Musculskeletal Infectins: Ostemyelitis and Sft tissue 5. Arthritis and Rheumatlgic Disrders 6. Bne tumrs and tumrlike cnditins including metastatic disease 7. Sft tissue masses 8. Hematlgic Disrders 9. Ischemic Bne Disease 10. Metablic Bne Disease 11. Endcrine and Hrmnal Disrders 12. Sft tissue calcificatins 13. Skeletal Dysplasias 14. Sprts Injuries Upper extremity 15. Sprts Injuries Lwer extremity This curriculum is supplemented by the fllwing interdisciplinary lectures: 1. Biweekly Mnday Case cnferences 2. Biweekly Thursday nn Jurnal club 3. Mnthly Rheumatlgy 4. Mnthly Surgical pathlgy 5. Mnthly Cancer cnference

2 MSK Radilgy Rtatin 1 General verview Radilgy resident rtatins in MSK Imaging will include at least 4 mnths during residency. Rtatins will ccur at St. Luke s Hspital f Kansas City and Truman Medical Center. The specific gals include bjectives required fr every level f training with graded supervisin by the attending faculty. All aspects f MSK imaging will be incrprated int the residency, including MSK crss- sectinal imaging (CT, MRI, and Ultrasund), Nuclear Medicine (Bne scan, Gallium scan, WBC scan) and Interventinal prcedures (jint injectins, aspiratins, bipsies, tumr ablatin). Resident respnsibilities: 1. Residents wrk directly with the attending MSK radilgist and are invlved in the daily cnduct f the service. At the beginning f every wrk day, the resident shuld be familiar with the patient schedule and anticipate needs fr any prcedures. The resident will check requisitins t evaluate the apprpriateness f requested study r if ther exams need t be perfrmed. Clinical infrmatin shuld be btained prir t prtcling MR and CT scans as well as prir t scheduling bipsies r ther interventinal prcedures. Absent clinical indicatin r seemingly inapprpriate requests will be clarified and discussed with the referring physician/service. 2. The resident assigned t the MSK rtatin is expected t be available fr cnsultatin by the imaging technlgists, clinicians and ther health care prfessinals during regular ffice hurs except during cnference times, when attending faculty will cver. 3. Examinatins shuld be checked by the resident befre the patient leaves the department if requested t d s by the supervising faculty. 4. Questins shuld be referred t the supervising faculty t which the resident is assigned. 5. Preliminary reprts may be written fr emergency rm studies and patients wh are ging t clinic appintments n the same day f the examinatin when apprpriate. This is cmmunicated t attending radilgist and dcumented in the final reprt with name, date and time f such a cmmunicatin. 6. Review f cases with the supervising faculty will be cnducted as many times in the day as necessary t keep an efficient wrk flw. 7. All studies shuld be dictated by the end f every wrking day. 8. The resident will check his/her reprts prir t final verificatin by supervising faculty. Staff respnsibilities: 1. Supervising faculty shuld be available at all times fr any questins r cnsultatins needed by the resident. 2. Supervising faculty shuld review all cases with the resident befre the end f the day. 3. Supervising faculty shuld prvide the resident with cnstructive feedback in any prblem areas encuntered during the rtatin as well as thrugh rtatin evaluatins. 4. Supervising faculty shuld sign resident- generated reprts in a timely manner and infrm the resident f any majr changes he/she made.

3 Resident evaluatin: UMKC faculty use n line electrnic evaluatins, which are based n the 6 ACGME cre cmpetencies. Residents are als evaluated by 1-2 technlgists and 10 patients while n each mnth f MSK Imaging rtatin. See the resident handbk fr further details. MSK Imaging - Rtatin 1 Gals and Objectives I. Patient care: (a) Residents are required t cmplete an n line Patient Care, Radiatin Safety mdule at least biannually. (b) The resident shuld have knwledge f indicatins fr the examinatins requested. When the reasn fr the examinatin is nt clear, the resident shuld effectively cmmunicate with the patient r referring physician until this is clarified. (c) The resident shuld be familiar with available medical recrds and hw t access them fr purpses f patient care. (d) All studies shuld be reviewed with supervising faculty attending. (e) Preliminary reprts shuld be made available t all referring clinicians if needed prir t final review f cases. If there is a significant discrepancy between the preliminary reading and final reading, the resident shuld ntify the referring clinician immediately. II. Medical Knwledge: At the end f the rtatin, the resident shuld be able t: (a) Discuss basic bne physilgy. (b) List and describe the basic principles f evaluatin f MSK imaging studies. (c) Describe apprpriate wrk- up f MSK disrders if radigraphs are negative; state whether the patient shuld underg CT, MRI, nuclear imaging, etc. (d) Arrange MSK studies in an rderly fashin fr review and interpretatin. (e) Recgnize cmmnly used radigraphic prjectins in MSK radilgy. (f) State indicatins fr CT, MRI, Ultrasund, bne scans and arthrgraphy (including MR arthrgraphy). (g) State indicatins fr IV r intra- articular cntrast n MRI and CT studies f MSK disrders. (h) Identify, with a high level f accuracy, mst types f skeletal fractures. (i) Describe the stages f fracture healing and identify stages f bne healing n radigraphs. (j) Identify nrmal musculskeletal structures and sme nrmal variants. (k) Identify nrmal vs. abnrmal skeletal structures (esp. n bne survey). (l) Establish bne age n the basis f radigraphic findings. (m) Make preliminary review f plain radigraphs and discuss findings with the radilgist, then dictate as directed. (n) Dictate films with assistance f the radilgist. () Assist the technlgist in preparatin f the patient fr flurscpic examinatin (e.g., arthrgrams, etc.) III. Practice Based Learning and Imprvement: (a) Residents are required t cmplete an n line Flurscpic Prcedures and Radiatin Safety mdule at least biannually. (b) The resident shuld demnstrate evidence f independent reading and learning thrugh the use f printed and electrnic surces. (c) Fllw- up f abnrmal r interesting studies shuld be accmplished thrugh cmmunicatin with the referring physician and/r patient medical recrds. (d) Residents shuld assist with preparatin and presentatin f cases fr interdisciplinary cnferences when requested by the attending physician. (e) The resident shuld be cmpetent in using the PACS and Pwerscribe systems in the daily accmplishment f the wrk lad and instruct thers in its use.

4 IV. Interpersnal Cmmunicatin Skills: (a) The resident shuld be able t cmmunicate effectively results f studies t referring clinicians whenever needed. Fr emergent studies, reprts t referring clinicians shuld be made in a timely manner. (b) The resident shuld be able t effectively cnvey the findings f examinatins thrugh accurate dictatin f reprts. (c) Residents shuld discuss flurscpic prcedures and study results with the patient and family when requested t d s by supervising faculty. V. Prfessinalism: (a) Residents are required t cmplete an n line prfessinalism mdule at least biannually. (b) Recgnize limitatins in persnal knwledge and skills, being careful t nt make decisins beynd the level f persnal cmpetence. (c) Residents shuld be able t explain the nature f the examinatin r findings in an examinatin t the patient and family when needed. (d) Residents shuld bserve ethical principles when recmmending further wrk- up fr cases. (e) Prmptness and availability at wrk are expected f every resident. (f) Residents shuld dress apprpriately at wrk, wearing a name badge at all times. (g) Technlgists and ther health wrkers shuld be treated with respect as part f the health care team. (h) Patient cnfidentiality shuld be bserved at all times. VI. System Based practice: (a) Residents shuld be familiar with departmental prcedures necessary in the perfrmance f the examinatin. (b) Residents shuld learn apprpriate language t be used in cmmunicating t clinicians thrugh reprts r cnsultatins s prper management decisins can be made. (c) Prper dictatins shuld be made with indicatins, technique, findings and cnclusins (d) Residents shuld dictate and crrect their reprts in a timely fashin t avid delay in patient dispsitin. (e) Residents shuld assist in facilitating examinatins whenever pssible. (f) Resident shuld recgnize the rle that nuclear medicine plays in the management f patient s illness and make prper recmmendatins when needed. (g) Residents are encuraged t make suggestins t imprve methds and systems utilized in radilgy shuld be made whenever apprpriate. Reading list: Fcus n nrmal anatmy and trauma. 1. Manaster et al. Diagnstic and Surgical Imaging Anatmy: Musculskeletal. Amirsys Greenspan. Orthpedic Imaging. A Practical Apprach. 4 th Editin. Lippinctt Williams & Wilkins Bhndrf K et al. Musculskeletal Imaging. A Cncise Multimdality Apprach. Thieme Keats & Andersn. Atlas f Nrmal Rentgen Variants that may simulate disease. 8 th Editin. Msby Rgers L. Radilgy f Skeletal Trauma, 3 rd Editin. Churchill Livingstne Manaster, May & Disler. Musculskeletal Imaging, 3 rd Editin: The Requisites. Msby ACR MSK Radilgy teaching file disc anatmy.rg

5 MSK Radilgy - Rtatin 2 General verview: Radilgy resident rtatins in MSK Imaging will include at least 4 mnths during residency. Rtatins will ccur at St. Luke s Hspital f Kansas City and Truman Medical Center. The specific gals include bjectives required fr every level f training with graded supervisin by the attending faculty. All aspects f MSK imaging will be incrprated int the residency, including MSK crss- sectinal imaging (CT, MRI, and Ultrasund), Nuclear Medicine (Bne scan, Gallium scan, WBC scan) and Interventinal prcedures (jint injectins, aspiratins, bipsies, tumr ablatin). Resident respnsibilities: 1. Residents wrk directly with the attending MSK radilgist and are invlved in the daily cnduct f the service. At the beginning f every wrk day, the resident shuld be familiar with the patient schedule and anticipate needs fr any prcedures. The resident will check requisitins t evaluate the apprpriateness f requested study r if ther exams need t be perfrmed. Clinical infrmatin shuld be btained prir t prtcling MR and CT scans as well as prir t scheduling bipsies r ther interventinal prcedures. Absent clinical indicatin r seemingly inapprpriate requests will be clarified and discussed with the referring physician/service. 2. The resident assigned t the MSK rtatin is expected t be available fr cnsultatin by the imaging technlgists, clinicians and ther health care prfessinals during regular ffice hurs except during cnference times, when attending faculty will cver. 3. Examinatins shuld be checked by the resident befre the patient leaves the department if requested t d s by the supervising faculty. 4. Questins shuld be referred t the supervising faculty t which the resident is assigned. 5. Preliminary reprts may be written fr emergency rm studies and patients wh are ging t clinic appintments n the same day f the examinatin when apprpriate. This is cmmunicated t attending radilgist and dcumented in the final reprt with name, date and time f such a cmmunicatin. 6. Review f cases with the supervising faculty will be cnducted as many times in the day as necessary t keep an efficient wrk flw. 7. All studies shuld be dictated by the end f every wrking day. 8. The resident will check his/her reprts prir t final verificatin by supervising faculty. Staff respnsibilities: 1. Supervising faculty shuld be available at all times fr any questins r cnsultatins needed by the resident. 2. Supervising faculty shuld review all cases with the resident befre the end f the day. 3. Supervising faculty shuld prvide the resident with cnstructive feedback in any prblem areas encuntered during the rtatin as well as thrugh rtatin evaluatins. 4. Supervising faculty shuld sign resident- generated reprts in a timely manner and infrm the resident f any majr changes he/she made.

6 Resident evaluatin: UMKC faculty will use n line sftware t cmplete electrnic evaluatins, which are based n the 6 ACGME cre cmpetencies. Residents are als evaluated by 1-2 technlgists and 10 patients while n each mnth f MSK Imaging rtatin. See the resident handbk fr further details. MSK Imaging Rtatin 2 Gals and Objectives I. Patient care: (a) Residents are required t cmplete an n line Patient Care, Radiatin Safety mdule at least biannually. (b) The resident shuld have knwledge f indicatins fr the examinatins requested. When the reasn fr the examinatin is nt clear, the resident shuld effectively cmmunicate with the patient r referring physician until this is clarified. (c) The resident shuld be familiar with available medical recrds and hw t access them fr purpses f patient care. (d) All studies shuld be reviewed with supervising faculty attending. (e) Preliminary reprts shuld be made available t all referring clinicians if needed prir t final review f cases. If there is a significant discrepancy between the preliminary reading and final reading, the resident shuld ntify the referring clinician immediately. II. Medical Knwledge: At the end f the rtatin, the resident shuld be able t: (a) Name and describe cmmn types f bne and jint trauma, ther than fractures, (i.e., sprts injuries) (b) Establish bne age n the basis f radigraphic findings. (c) Name and differentiate between the varius frms f arthritis, including labratry and clinical findings f each type. (d) State the radigraphic features that distinguish aggressive and nnaggressive bne lesins (patterns f stelysis and peristitis) (e) Name and describe clinical, pathlgical and radilgical features f cngenital and acquired bne pathlgies. (f) Name and describe clinical, pathlgical and radilgical features f metablic bne diseases. (g) Describe radigraphic features f inflammatry bne and jint disrders. (h) Identify the fllwing categries f bne pathlgy n imaging studies: i. inflammatry/infectius prcesses ii. tumr and tumr- like cnditins iii. cngenital and acquired diseases iv. metablic disrders v. trauma (i) Describe nrmal findings and cmplicatins in patients with jint replacements. (j) Demnstrate increasing skill in quality and quantity f dictatin f MSK images. (k) Demnstrate decisin- making and value judgement skills: at the end f the rtatin, the resident shuld be able t review radigraphs and clinical histry, and then make a decisin abut apprpriateness f additinal imaging and patient management. (l) Add t knwledge base thrugh cntinued reading f films and case reviews. (m) Perfrm image guided prcedures with the assistance f the radilgist. (n) Dictate films with assistance f the radilgist. III. Practice Based Learning and Imprvement: (a) Residents are required t cmplete an n line Flurscpic Prcedures and Radiatin Safety mdule at least biannually.

7 (b) The resident shuld demnstrate evidence f independent reading and learning thrugh the use f printed and electrnic surces. (c) Fllw- up f abnrmal r interesting studies shuld be accmplished thrugh cmmunicatin with the referring physician and/r patient medical recrds. (d) Residents shuld assist with preparatin and presentatin f cases fr pediatric interdisciplinary cnferences when requested by the attending physician. (e) The resident shuld be cmpetent in using the PACS and Pwerscribe systems in the daily accmplishment f the wrk lad and instruct thers in its use. Interpersnal Cmmunicatin Skills: (a) Residents shuld be able t cmmunicate effectively results f studies t referring clinicians whenever needed. Fr emergent studies, reprts t referring clinicians shuld be made in a timely manner. (b) The resident shuld be able t effectively cnvey the findings f examinatins thrugh accurate dictatin f reprts. (c) Residents shuld discuss flurscpic prcedures and study results with children and their families when requested t d s by supervising faculty. Prfessinalism: (a) Residents are required t cmplete an n- line prfessinalism mdule r ther prfessinalism at least biannually. (b) Recgnize limitatins in persna skill and knwledge, always making sure dictatins and cnsultatins are check by the radilgist in charge. (c) Recgnize limitatins in persnal knwledge and skills, being careful t nt make decisins beynd the level f persnal cmpetence. (d) Residents shuld be able t explain the nature f the examinatin r findings in an examinatin t patients and their families when needed. (e) Residents shuld bserve ethical principles when recmmending further wrk- up fr cases. (f) Prmptness and availability at wrk are expected f every resident. (g) Residents shuld dress apprpriately at wrk, wearing a name badge at all times. (h) Technlgists and ther health wrkers shuld be treated with respect as part f the health care team. (i) Patient cnfidentiality shuld be bserved at all times. System Based practice: (a) Residents shuld be familiar with departmental prcedures necessary in the perfrmance f the examinatin. (b) Residents shuld learn apprpriate language t be used in cmmunicating t clinicians thrugh reprts r cnsultatins s prper management decisins can be made. (c) Prper dictatins shuld be made with indicatins, technique, findings and cnclusins (d) Residents shuld dictate and crrect their reprts in a timely fashin t avid delay in patient dispsitin. (e) Residents shuld assist in facilitating examinatins whenever pssible. (f) Resident shuld recgnize the rle that nuclear medicine plays in the management f patient s illness and make prper recmmendatins when needed. (g) Residents are encuraged t make suggestins t imprve methds and systems utilized in radilgy shuld be made whenever apprpriate. Reading list: Fcus n arthritides, inflammatry/infectius prcesses, tumr and tumr- like cnditins, metablic bne disrders, cngenital and acquired disrders, advanced imaging f bne and jint trauma. 1. Resnick, Sang and Pretterklieber. Internal Derangements f Jints, 2nd Editin. Saunders Resnick and Kransdrf. Bne and Jint Imaging, 3 rd Editin. Elsevier

8 3. Brwer AC. Arthritis in Black and White. WB Saunders. 4. Stller s Atlas f Orthpedics and Sprts Medicine. Lippinctt Williams & Wilkins Stller. Magnetic Resnance in Orthpaedics and Sprts Medicine. Lippinctt Williams & Wilkins. 3 rd Editin Kransdrf & Murphey. Imaging f Sft tissue tumrs. 2 nd Editin. Lippinctt Williams & Wilkins Bhndrf K et al. Musculskeletal Imaging. A Cncise Multimdality Apprach. Thieme Keats & Andersn. Atlas f Nrmal Rentgen Variants that may simulate disease. 8 th Editin. Msby Rgers L. Radilgy f Skeletal Trauma. Churchill Livingstne. 10. Manaster, May & Disler. Musculskeletal Imaging, 3 rd Editin: The Requisites. Msby ACR MSK Radilgy teaching file disc anatmy.rgwww.acr.rg MSK Radilgy Rtatin 3 and ptinal 4, 5, r 6 General verview Radilgy resident rtatins in MSK Imaging will include at least 4 mnths during residency. Rtatins will ccur at St. Luke s Hspital f Kansas City and Truman Medical Center. The specific gals include bjectives required fr every level f training with graded supervisin by the attending faculty. All aspects f MSK imaging will be incrprated int the residency, including MSK crss- sectinal imaging (CT, MRI, and Ultrasund), Nuclear Medicine (Bne scan, Gallium scan, WBC scan) and Interventinal prcedures (jint injectins, aspiratins, bipsies, tumr ablatin). Resident respnsibilities: 1. Resident wrk directly with the attending MSK radilgist and are invlved in the daily cnduct f the service. At the beginning f every wrk day, the resident shuld be familiar with the patient schedule and anticipate needs fr any prcedures. The resident will check requisitins t evaluate the apprpriateness f requested study r if ther exams need t be perfrmed. Clinical infrmatin shuld be btained prir t prtcling MR and CT scans as well as prir t scheduling bipsies r ther interventinal prcedures. Absent clinical indicatin r seemingly inapprpriate requests will be clarified and discussed with the referring physician/service. 2. The resident assigned t the MSK rtatin is expected t be available fr cnsultatin by the imaging technlgists, clinicians and ther health care prfessinals during regular ffice hurs except during cnference times, when attending faculty will cver. 3. Examinatins shuld be checked by the resident befre the patient leaves the department if requested t d s by the supervising faculty. 4. Questins shuld be referred t the supervising faculty t which the resident is assigned. 5. Preliminary reprts may be written fr emergency rm studies and patients wh are ging t clinic appintments n the same day f the examinatin when apprpriate. This is cmmunicated t attending radilgist and dcumented in the final reprt with name, date and time f such a cmmunicatin. 6. Review f cases with the supervising faculty will be cnducted as many times in the day as necessary t keep an efficient wrk flw.

9 7. All studies shuld be dictated by the end f every wrking day. 8. The resident will check his/her reprts prir t final verificatin by supervising faculty. Staff respnsibilities: 1. Supervising faculty shuld be available at all times fr any questins r cnsultatins needed by the resident. 2. Supervising faculty shuld review all cases with the resident befre the end f the day. 3. Supervising faculty shuld prvide the resident with cnstructive feedback in any prblem areas encuntered during the rtatin as well as thrugh rtatin evaluatins. 4. Supervising faculty shuld sign resident- generated reprts in a timely manner and infrm the resident f any majr changes he/she made. Resident evaluatin: UMKC faculty will use n line sftware t cmplete electrnic evaluatins, which are based n the 6 ACGME cre cmpetencies. Residents are als evaluated by 1-2 technlgists and 10 patients while n each mnth f MSK Imaging rtatin. See the resident handbk fr further details. MSK Imaging Rtatin 3 (ptinal 4-6) Gals and Objectives I. Patient care: (a) Residents are required t cmplete an n line Patient Care, Radiatin Safety mdule at least biannually. (b) The resident shuld have knwledge f indicatins fr the examinatins requested. When the reasn fr the examinatin is nt clear, the resident shuld effectively cmmunicate with the patient r referring physician until this is clarified. (c) The resident shuld be familiar with available medical recrds and hw t access them fr purpses f patient care. (d) All studies shuld be reviewed with supervising faculty attending. (e) Preliminary reprts shuld be made available t all referring clinicians if needed prir t final review f cases. If there is a significant discrepancy between the preliminary reading and final reading, the resident shuld ntify the referring clinician immediately. II. Medical Knwledge: At the end f the rtatin, the resident shuld be able t: (a) Describe fractures, rheumatlgic disrders, sft tissue and bne tumrs, infectius prcesses, cngenital and metablic disrders affecting the musculskeletal structures. Discuss in detail the pathphysilgy f these disrders and be able t frmulate apprpriate differential diagnses. (b) Advise referring physicians n when imaging mdalities such as radigraphy, tmgraphy, CT, nuclear medicine studies and MRI shuld be used t evaluate specific musculskeletal disrders. Discuss their relative strengths and weaknesses. (c) Describe the technique and applicatin f cnventinal arthrgraphy and MR r CT arthrgraphy as well as hw t interpret arthrgrams f the shulder, elbw, wrist, hip and knee. Shw prficiency in perfrming arthrgrams and jint injectins/aspiratins. (d) Discuss the physics f radigraphy, CR and DR, as it pertains t bne and sft tissue. (e) Discuss the basic physics f magnetic resnance imaging and understand technical variables fr differing MR scan prtcls including the principles behind different pulse sequences, time t repetitin, time t ech, cil implementatin, spacing, scan time and causes f artifacts. (f) Recgnize nrmal and abnrmal crss sectinal anatmy f the musculskeletal structures in all three (sagittal, axial and crnal) imaging planes. Recgnize the nrmal appearance f different cmpnents f sft tissue (such as fat, fibrus tissue, muscle) and bne (crtical and medullary) n varius pulse sequences.

10 (g) Recgnize abnrmalities such as internal derangement f jints, tumr, infectius prcesses and metablic disrders affecting the musculskeletal system. (h) Use cntrast administratin (IV, intra- articular) apprpriately fr jint imaging and sft tissue tumr imaging. (i) Add t knwledge base in all areas f musculskeletal radilgy thrugh cntinued study, review f ACR cases and film reading. (j) Perfrm flurscpic exams except when cmplicatins are anticipated. (k) Participate in perfrmance and interpretatin f interventinal prcedures under faculty supervisin. (a) Dictate films nearly independently with little assistance frm the radilgist. III. Practice Based Learning and Imprvement: (a) Residents are required t cmplete an n line Flurscpic Prcedures and Radiatin Safety mdule at least biannually. (b) The resident shuld demnstrate evidence f independent reading and learning thrugh the use f printed and electrnic surces. (c) Fllw- up f abnrmal r interesting studies shuld be accmplished thrugh cmmunicatin with the referring physician and/r patient medical recrds. (d) Residents shuld assist with preparatin and presentatin f cases fr pediatric interdisciplinary cnferences when requested by the attending physician. (e) The resident shuld be cmpetent in using the PACS and Pwerscribe systems in the daily accmplishment f the wrk lad and instruct thers in its use. IV. Interpersnal Cmmunicatin Skills: (a) Residents shuld be able t cmmunicate effectively results f studies t referring clinicians whenever needed. Fr emergent studies, reprts t referring clinicians shuld be made in a timely manner. (b) The resident shuld be able t effectively cnvey the findings f examinatins thrugh accurate dictatin f reprts. (c) Residents shuld discuss flurscpic prcedures and study results with children and their families when requested t d s by supervising faculty. V. Prfessinalism: (a) Residents are required t cmplete an n line prfessinalism mdule at least biannually. (b) At the end f the rtatin, the resident shuld be able t make preliminary decisins n all matters f film interpretatin and cnsultatin, recgnizing and btaining assistance with situatins that require the expertise f the radilgist. (c) Recgnize limitatins in persnal knwledge and skills, being careful t nt make (d) decisins beynd the level f persnal cmpetence. (e) Residents shuld be able t explain the nature f the examinatin r findings in an examinatin t patients and their families when needed. (f) Residents shuld bserve ethical principles when recmmending further wrk- up fr cases. (g) Prmptness and availability at wrk are expected f every resident. (h) Residents shuld dress apprpriately at wrk, wearing a name badge at all times. (i) Pediatric radilgy technlgists and ther health wrkers shuld be treated with respect as part f the health care team. (j) Patient cnfidentiality shuld be bserved at all times. VI. System Based practice: (a) Residents shuld be familiar with departmental prcedures necessary in the perfrmance f the examinatin.

11 (b) Residents shuld learn apprpriate language t be used in cmmunicating t clinicians thrugh reprts r cnsultatins s prper management decisins can be made. (c) Prper dictatins shuld be made with indicatins, technique, findings and cnclusins (d) Residents shuld dictate and crrect their reprts in a timely fashin t avid delay in patient dispsitin. (e) Residents shuld assist in facilitating examinatins whenever pssible. (f) Resident shuld recgnize the rle that nuclear medicine plays in the management f patient s illness and make prper recmmendatins when needed. (g) Residents are encuraged t make suggestins t imprve methds and systems utilized in radilgy shuld be made whenever apprpriate. Reading list: Fcus n filling in gaps in knwledge and study by taking cases in an ral bard frmat. Review material learned n previus rtatins in MSK radilgy. 1. Resnick and Kransdrf. Bne and Jint Imaging, 3 rd Editin. Elsevier Resnick, Sang and Pretterklieber. Internal Derangements f Jints, 2nd Editin. Saunders Stller. Magnetic Resnance in Orthpaedics and Sprts Medicine. Lippinctt Williams & Wilkins. 3 rd Editin Kransdrf & Murphey. Imaging f Sft tissue tumrs. 2 nd Editin. Lippinctt Williams & Wilkins Bhndrf K et al. Musculskeletal Imaging. A Cncise Multimdality Apprach. Thieme Manaster, May & Disler. Musculskeletal Imaging, 3 rd Editin: The Requisites. Msby Cmplete ACR MSK Radilgy teaching file disc anatmy.rgwww.acr.rg 11.

12 Supplimental materials fr MSK Musculskeletal (MSK) Imaging Rtatins General guidelines Infrm attending if yu will be late r absent Review cases prir t read-ut with attending Obtain clinical infrmatin frm electrnic recrd r referring service Must cmpare and crrelate with previus exams including ther mdalities (radigraphs, CT, MRI, nuclear medicine, US) Must address specific clinical questins n physician request Read abut disrder and anatmy Check schedule: weekly and daily fr image guided prcedures Review technique befre day f prcedure Maintain lg f prcedures and fllw-up results f bipsy r aspiratin Dictate addendum with final pathlgy results fr bipsy r FNA Rtatin 1 MSK Imaging Gals After cmpleting the first 4-week rtatin, the resident will be able t: Demnstrate learning f knwledge based bjectives and mastery f technical bjectives fr the first rtatin Generate accurate and cncise radigraphic reprts Cmmunicate effectively with patients, referring clinicians, technlgists and supervisry staff Understand standard radigraphic psitining and anatmy Obtain essential patient infrmatin pertinent t the imaging study Demnstrate knwledge f clinical indicatins fr radigraphy and indicatins fr urgent cmputed tmgraphy (CT) and magnetic resnance (MR) scans Demnstrate a respnsible wrk ethic Participate in quality imprvement/ quality assurance activities Participate in educatin f students and interns Objectives Knwledge based

13 Demnstrate learning f nrmal radigraphic and CT anatmy f axial and appendicular skeletn Recgnize and accurately describe cmmn fractures and dislcatins f appendicular skeletn Recgnize and describe fractures and dislcatins f the cervical, thracic and lumbar spine. Understand basic mechanisms f injury and distinguish stable frm unstable injuries Demnstrate learning f pathphysilgy and radilgy f fracture healing and cmplicatins f healing such as delayed unin, malunin and nnunin Demnstrate learning f radigraphic presentatin and evaluatin f stemyelitis and septic arthritis Recgnize and describe cmplicatins f rthpedic devices including fracture fixatin and spine and arthrplasty hardware Demnstrate learning f nrmal MRI anatmy f knee and shulder Demnstrate learning f nrmal MRI anatmy f cervical, thracic, and lumbar spine Technical Dictate clear, detailed, and accurate reprts that include all pertinent infrmatin as established in the American Cllege f Radilgy (ACR) Guidelines fr Cmmunicatin 4 Use apprpriate nmenclature when reprting radigraphic, CT, MR r ultrasund (US) findings f musculskeletal disease Cmmunicate all unexpected r significant findings t the rdering prvider and dcument whm was called and the date and time f the discussin in the reprt Obtain relevant patient histry frm electrnic recrds, dictated reprts, the patient, r by cmmunicatin with referring prvider Recgnize and describe psitining and anatmy f standard radigraphic examinatins f the musculskeletal system Effectively prvide feedback t radilgy technlgists regarding quality f expsure and patient psitining Recgnize when it is apprpriate t btain help frm senir residents r faculty when assisting referring clinicians Demnstrate respnsible, ethical behavir; psitive wrk habits; and prfessinal appearance; and adhere t principles f patient cnfidentiality Participate in discussins with faculty and staff regarding peratinal challenges and ptential system slutins regarding all aspects f radilgic services and patient care

14 Rtatin 2 MSK Imaging Gals After cmpleting the secnd 4-week rtatin, the resident will be able t: Demnstrate learning f knwledge based bjectives and mastery f technical bjectives fr the secnd rtatin Cntinue t build and imprve n skills develped during the first rtatin Develp skills in prtcling and mnitring CT and MR examinatins Demnstrate an understanding f the ACR Apprpriateness Criteria 5 and ACR Practice Guidelines and Technical Standards fr musculskeletal imaging 6 Participate in the educatin f junir residents, interns, and medical students Perfrm image guided prcedures Objectives Knwledge Based Recgnize and describe radigraphic presentatin f Paget disease Demnstrate learning f a systematic apprach t arthritis. Be able t describe and differentiate salient radilgic (radigraphic, CT and MR) features f cmmn arthrpathies including stearthritis, inflammatry arthrpathy (rheumatid, psriatic, reactive, juvenile chrnic, and septic), crystal depsitin diseases (calcium pyrphsphate depsitin, gut, hydrxyapatite depsitin), neurpathic arthrpathy, cnnective tissue disease (systemic lupus erythematsis, sclerderma, dermatmysitis), pigmented villndular synvitis, and synvial chndrmatsis Demnstrate a systematic assessment f a slitary lesin f bne and be able t categrize the lesin as aggressive r nnaggressive. Develp an apprpriate differential diagnsis based n patient age, lesin lcatin, and lesin characteristics (margin, matrix, peristeal reactin, sft tissue extensin). Demnstrate knwledge f systematic, safe and cst effective radilgic wrk-up f bne lesins including bipsy apprach and cmpartmental anatmy. Recgnize and describe cmmn lcatins f and radilgic manifestatins f stenecrsis. Demnstrate knwledge f MRI safety issues including cntraindicatin t scanning and use f cntrast. Demnstrate learning f the use f varius pulse sequences and planes f imaging used in MRI f musculskeletal disrders Demnstrate learning f cmmn knee and shulder pathlgy n MRI (meniscal tear, tendn and ligament injury, fracture, chndral disease, rtatr cuff tear, and labral pathlgy) Demnstrate learning f cmmn pathlgy f the cervical, thracic, and lumbar spine n MRI Demnstrate learning f the nrmal MRI anatmy f the hip and ankle Technical Build and imprve n skills acquired during first rtatin

15 Demnstrate the ability t gather essential and accurate patient infrmatin (electrnic, persnal cmmunicatin) t apprpriately prescribe MRI prtcls Prvide effective and timely feedback and educatin t CT and MRI technlgists regarding quality f examinatins Demnstrate ability t mnitr CT and MRI examinatins t ensure the patient is adequately evaluated Demnstrate an understanding f indicatins, cntraindicatins, needle path, risks and pst prcedural management f CT and US guided prcedures including management f cmplicatins Prvide technical and educatinal guidance t junir residents and students Safely perfrm flurscpically guided jint injectins and aspiratins with faculty supervisin Demnstrate an understanding f indicatins, cntraindicatins, radiatin risks, and pst prcedural management f flurscpically guided prcedures including management f cmplicatins Demnstrate an ability t cunsel a patient and btain infrmed cnsent befre perfrming a prcedure, including a descriptin f the prcedure, risks, benefits, and alternatives; and slicit and respnd t patient questins withut discriminatin based n religius, ethnic, sexual, ecnmic, r educatinal differences Maintain a lg f all prcedures perfrmed including cmplicatins Rtatin 3 MSK Imaging Gals After cmpleting the third 4-week, the resident will be able t: Demnstrate learning f knwledge based bjectives and mastery f technical bjectives fr the third rtatin Cntinue t refine skills develped during the first tw rtatins Effectively use infrmatin technlgy t address clinical prblems Participate in the educatin f junir residents and medical students Becme a mre independent prvider f musculskeletal radilgic interpretive services Manage clinical and technical questins frm technical and supprt staff Objectives Knwledge based Recgnize radilgic findings and describe pathphysilgy f endcrine disease including hyperparathyridism, renal stedystrphy, stemalacia/rickets, hypphsphatasia, hypphsphatemia

16 Recgnize radilgic findings f hematpietic and strage diseases including sickle cell anemia, thalassemia, mastcytsis, and Gaucher s disease. Demnstrate systematic apprach t relatively cmmn dysplasias and cngenital cnditins such as achndrplasia, stegenesis imperfecta, stepetrsis Demnstrate learning f cmmn pathlgy f the hip and ankle n MRI Demnstrate learning f anatmy and cmmn injuries/pathlgy f the elbw and wrist n MRI Technical Imprve and build n skills acquired during the first tw rtatins Demnstrate the ability t lcate, appraise and assimilate evidence frm scientific studies related t the perfrmance and interpretatin f musculskeletal imaging Demnstrate the ability t teach a junir clleague hw t prtcl examinatins and plan prcedures Demnstrate the ability t assess and priritize requests fr add-n prcedures Demnstrate the ability t answer cmmn prcedural and plicy questins frm technlgists and supprt staff References 1. Accreditatin Cuncil fr Graduate Medical Educatin. Cmpetencies Definitins and Practice Perfrmance Measurements fr Diagnstic Radilgy. Available nline at Accessed 9/01/ Accreditatin Cuncil fr Graduate Medical Educatin. Prgram Requirements fr Graduate Medical Educatin in Diagnstic Radilgy. Available nline at Accessed 9/05/06 3. Cllins J, Abbtt GF, Hlbert JM, et al. Revised Curriculum n Cardithracic Radilgy fr Diagnstic Radilgy Residency With Gals and Objectives Related t General Cmpetencies. Acad Radil 2005; 12: American Cllege f Radilgy. ACR Practice Guideline fr Cmmunicatin f Diagnstic Imaging Findings. Available nline at Accessed 9/06/ American Cllege f Radilgy. ACR Apprpriateness Criteria: Expert Panel n Musculskeletal Imaging. Available nline at Accessed 9/06/ American Cllege f Radilgy. ACR Practice Guidelines and Technical Standards. Available nline at Accessed 9/06/06.